KARE Plan - Health and Dental Benefits for Children in Care

For three decades, Morneau Sobeco has had a long-standing relationship with the Ontario Association of Children’s Aid Societies (OACAS) to provide benefits consulting services.

In the mid-90’s, it was identified that no consistent approach existed for providing health and dental benefits for children in care at each of the 53 Children's Aid Societies (CASs) in Ontario. These agencies were concerned that having different processes for delivering health and dental benefits meant there was a lack of efficiency, administration and reporting as well as cost-effectiveness.

Upon hearing these concerns, Morneau Sobeco undertook a process that began with interviewing a number of the agencies to determine the processes in place, and listening to their “wishes” for improvement.

In response to these concerns, Morneau Sobeco designed the proprietary KARE Plan to provide effective delivery of extended health and dental benefits to children in care, with an enhanced focus on the child, as well as service improvements for the foster parent. The mandate of this plan, for the agencies involved, is to:

• decrease health and dental costs

• allow for portability of children’s drug and dental records

• create a child health and dental database

• allow for streamlined administration, to reduce reliance on internal resources

• provide enhanced reporting

For the foster parent, the advantages are fewer out-of-pocket costs and less paperwork. For the child, there is better medical and dental care through more consistent records and review at the point of purchase. Agencies not involved in the KARE Plan have invoices from multiple providers (such as pharmacies and dentists), and often are required to write special purchase orders.

The KARE Plan is celebrating 10 years of success this year (1998-2008). Today, 24 Children's Aid Societies participate in the KARE Plan with more than 10,000 children in care being covered.

The following agencies currently participate in the KARE Plan:

The KARE Plan continues to offer unique cost containment opportunities that otherwise would not be available if each participating agency had continued to process claims internally.

This initiative has introduced several automatic cost control features, including:

• drug utilization review

• dispensing fee cap

• national pricing policy for drug ingredient costs

• intervention edits*

*Identifying claims submitted to the KARE plan for children that have been discharged, duplicate claims or claims submitted by an ineligible provider.

For the 2007 policy year, approximately $10.1 million of health and dental claims were adjudicated and processed. As a result of the cost control features and intervention edits, the KARE Plan members saved over $1.4 million over the past year. This represents 14 percent of all claims paid during the 2007 policy year.

Previous article: Why Do the Youth on My Caseload Harm Themselves? Communications As a Possible Factor in Youth Deliberate Self-Harm

Next article: Discovering Your Supervisory Style